MCQs on Lung Cancer

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

A 64-year-old man presents with a chronic cough and recent unintentional weight loss. He has a 45-pack-year smoking history and worked for over 20 years in shipbuilding. He drinks alcohol socially and has no significant family history of cancer. A chest X-ray shows a suspicious lesion in the right upper lobe.
Which one of the following is the most significant risk factor for the development of lung cancer in this patient?

A) Alcohol consumption
B) Passive smoking
C) Asbestos exposure
D) Smoking history
E) Advanced age

Correct Answer: D) Smoking history

Explanation:
Cigarette smoking is the most important risk factor for lung cancer, responsible for approximately 85–90% of all cases. The patient’s 45-pack-year history significantly increases his risk. While asbestos exposure (especially in shipbuilding) is also a known risk factor, its carcinogenic potential is greatly amplified when combined with smoking.

Option A (Alcohol consumption): Not a primary risk factor for lung cancer.
Option B (Passive smoking): A risk factor, but far less significant than active smoking.
Option C (Asbestos exposure): Important, but less significant than direct tobacco use.
Option E (Advanced age): Lung cancer is more common in older adults, but age is a non-modifiable and less potent factor compared to smoking.

Question 2

A 58-year-old woman presents with progressive dyspnoea, weight loss, and fatigue. She has a 30-pack-year smoking history. Imaging reveals a centrally located mass in the right lung with mediastinal lymphadenopathy. Biopsy confirms small cell carcinoma.
Which of the following best describes the management approach for this patient?

A) Surgical resection
B) Stereotactic radiotherapy
C) Chemotherapy and radiotherapy
D) Observation and follow-up
E) Immunotherapy only

Correct Answer: C) Chemotherapy and radiotherapy

Explanation:
Small cell lung cancer (SCLC) is aggressive, centrally located, and typically not amenable to surgery due to early spread. The mainstay of treatment is combination chemotherapy and radiotherapy, particularly for limited-stage disease.

Option A (Surgical resection): Generally not used in SCLC because most patients present with advanced disease.
Option B (Stereotactic radiotherapy): Used more commonly in early-stage non-small cell lung cancer.
Option D (Observation): Not appropriate; SCLC is rapidly progressive.
Option E (Immunotherapy only): Immunotherapy may be added in extensive-stage disease, but not as monotherapy for initial treatment.

Question 3

A 70-year-old man with a history of heavy smoking presents with confusion, nausea, and lethargy. On examination, he is disoriented. Blood tests reveal serum sodium of 118 mmol/L. CT of the chest reveals a centrally located lung mass with mediastinal invasion.
Which of the following is the most likely cause of his hyponatraemia?

A) Renal failure
B) Adrenal insufficiency
C) Syndrome of inappropriate antidiuretic hormone (SIADH)
D) Diuretic use
E) Hyperglycaemia

Correct Answer: C) Syndrome of inappropriate antidiuretic hormone (SIADH)

Explanation:
SIADH is a well-recognised paraneoplastic syndrome associated with small cell lung cancer (SCLC), which typically presents as a central mass. Excess secretion of ADH leads to water retention and dilutional hyponatraemia, often presenting with confusion and lethargy.

Option A (Renal failure): Can cause hyponatraemia but usually with elevated creatinine and urea.
Option B (Adrenal insufficiency): Causes hyponatraemia, but less commonly paraneoplastic in lung cancer.
Option D (Diuretic use): Would require history of medication, not mentioned here.
Option E (Hyperglycaemia): Can cause pseudohyponatraemia, but usually not this profound.

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3. Respiratory Module

3.1 Asthma & COPD

3.2 Pulmonary Vascular Diseases

3.3 Pleural Diseases

3.4 Lung Cancer

3.5 Other Lung Diseases